Telehealth Across State Lines: Opportunities and Challenges

By Jeffrey E. Barnett, Psy.D., ABPP & Ofer Zur, Ph.D.

 

The use of telehealth technology to provide clinical services to clients presents both opportunities and challenges. For those clients who are unable to attend one or more appointments in person due to factors such as illness, transportation limitations, going on vacation or sabbatical, and the like, the use of the telephone, Email, or televideo communications technologies may be of great benefit. Rather than experience an interruption in treatment or need to refer the client to a new professional for a limited period of time, treatment can typically be continued with relative ease using these technologies. Of course, the use of telephone or Email bring with them some communication limitations such as the absence of visual cues, but because this is a continuation of treatment that has previously been provided in person the ability to offer treatment continuity is of great value.

For those clients seeking initial assessment and treatment through telehealth technology a number of challenges exist that aren’t present when there is a pre-existing in-person treatment relationship. The ability to perform an initial assessment of the individual’s treatment needs may be limited by the absence of visual cues unless televideo technologies are used. Also, without a video component it may be difficult to know just to whom you are interacting and if it is in fact the same person each time. An additional challenge concerns the need to arrange for emergency coverage in the locale where the client resides. It will be important to become familiar with the local resources there and to develop a plan that the client consents to that can be implemented in cases of crisis or emergency.

Regardless of whether telehealth services are provided to ongoing or new clients it is likely safe to assume that many clients accessing these services will not reside in the psychotherapist’s local area. Telehealth services frequently are provided over great distances. This is actually one of its great benefits. For many who live in areas with limited mental health resources and for those who are seeking specialized services that can’t be accessed in person locally, the use of telehealth services across great distances may be a godsend. For, without it, they might not be able to receive the treatment they are so in need of.

Despite all these great benefits for clients one potential additional challenge that must be addressed is the provision of clinical services across state lines (or even across nations’ borders!). While all mental health professionals know that they must be licensed to provide professional services independently, invariably they will be licensed in the jurisdiction where their office is physically located. The challenge involves the fact that with telehealth, now professional services are being provided both where the mental health professional is located physically as well as where the client is located physically. This raises the question “Must the professional be licensed in both jurisdictions?” If not, one may be providing services legally in one’s own jurisdiction but illegally (practicing without a license) in the other jurisdiction.

Practicing across states’ lines is one of the most complex issues regarding telehealth in general and web based technology in particular. This is because the boundary-less or the global nature of the Internet is not easily reconcilable with borders that define countries or states. While some states mandate that therapists be licensed in the state where the client resides, others allow brief practice across state lines. Other states have not yet articulated clear guidelines on the topic.

In one large national survey of mental health professionals who provide telehealth services Maheu and Gordon (2000) found that 75% of those surveyed were providing mental health treatment services across state lines in jurisdictions where they were not licensed to practice. Of perhaps even greater concern they found that only 60% of those surveyed even asked telehealth clients about their state of residence. Finally, 74% of those surveyed “were uncertain or incorrectly answered if their states currently had any telemedicine or telehealth laws” (p. 485).

As Koocher and Morray (2000) recommend, it is of vital importance that all telehealth practitioners learn the relevant laws regarding telehealth in any jurisdictions where they plan to offer services (to include where the services are received) and to not provide these services unless appropriately credentialed to do so.

References
Maheu, M.M., & Gordon, B.L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31, 484-489.
Koocher, G.P., & Morray, E. (2000). Regulation of telepsychology: A survey of state attorneys general. Professional Psychology: Research and Practice, 31, 503-508.

Online Resources:
Telehealth: Consulting across borders: http://findarticles.com/p/articles/mi_qa3925/is_200105/ai_n8948046/pg_1